Risks in Electrodiagnostic Medicine

There is a need for practitioners to be knowledgeable about potential complications from nerve conduction studies and needle electromyography as well as to know how to reduce the risk of such complications. Since a summary of risks inherent to electrodiagnostic (EDX) medicine was first published over one decade ago, publication of additional literature and technological advances warrant reassessment of this topic. Other relevant practice topics that were initially published independently are unified into this document to provide the reader with updated information on the risks of EDX medicine. INTRODUCTION AND METHODOLOGY When electrodiagnostic (EDX) testing is performed on patients with certain underlying medical conditions, the EDX physician should consider the potential risks of the procedure. Literature regarding risks and complications of EDX testing is limited. The following updates the original version of this document published in 19991. It provides information and guidance to approach some common problems encountered by EDX physicians. Ultimately, physician judgment must be utilized to manage individual patient circumstances. A search of medical databases (Cochrane Database of Systematic Reviews, PubMed NLM, MEDLINE (1966–2004), and MEDLINE In-Process) was performed in March 2009 by the AANEM Professional Practice Committee. Another search was performed in August 2011 and March 2012. Searches were performed using the terms: “electromyography or EMG or EMG needles or nerve conduction” cross-referenced with “lymphedema or lymph node dissection or lymph node excision,” “pregnancy and complication,” “pregnancy and standards,” “pregnancy and contraindication,” “hematoma or bleeding,” “defibrillator or pacemaker,” and “joint prosthesis or arthoplasty, replacement”. Additional pertinent articles were obtained through cross-reference of bibliographies of previously identified articles. The search for literature included only articles written in English. INFECTION CONTROL Infection control is an important issue in the EDX laboratory. The chances of transmitting bloodborne pathogens from patients to EDX physicians and staff, from EDX physicians and staff to patients, and from EDX equipment to patients must be minimized. The Occupational Safety and Health Administration (OSHA) has published standards2 regarding bloodborne pathogens (29 Code of Federal Regulations§1910.1030; http:// www.osha.gov/pls/oshaweb/owadisp.show_document?p_ table=STANDARDS&p_id=10051). The rule applies to all persons exposed occupationally to blood or other potentially infectious materials. It outlines preventive measures, such as hepatitis B vaccination (HBV) and universal precautions, and certain methods of control, including engineering and work practice controls, personal protective equipment, and housekeeping procedures. Other preventative measures involve what to do if an exposure incident occurs. Use of masks and gowns may be required depending on the individual case. OSHA also requires the creation of an exposure control plan, whereby employees are informed of hazards associated with bloodborne pathogens, and maintenance of certain medical records. The OSHA document and additional publications from the Centers for Disease Control3-8 set the standards concerning occupational exposure to blood or other potentially infectious materials. Transmission of Bloodborne Pathogens Between Patients and Healthcare Workers